djam's therapy thread

[djams]

So you might think about the buckwheat hull pillow trick...needs to be a heavy pillow though.

I finally picked one up. It's a dually - millet hull on one side and buckwheat hull on the other. Got it home, took it out of the box and "crap this thing isn't big enough". But, since I had it out, laid down and tried it while laying on my side. It just felt "right" - same thing when I rolled onto my back.

Anyways - I'm using it to sleep for the past 2 nights(buckwheat side against my cheek), and for whatever reason, I'm staying on my side! Not sure why this pillow would make such a difference. And it IS only 2 nights, both just under 1.0 AHI. I think this pillow is a keeper.

[djams]

I've decided that I'm going to be making my tweaks on a weekly schedule. I was looking at the SleepyHead Statistics page, and I've definitely been dial winger as of late. I'm at 7 days on my last change, so I'm letting you know the results, and what I'm thinking I should do next. Hopefully I'll get "seems reasonable", or a "NO, you dolt!" type feedback.

For the week, average AHI 1.17, Max 2.28/Min 0.01 (<-crazy, 1 hypo last night). The average is obviously skewed by last night's .01 - but it was a good week for me overall.

Pugsy's Pillow recommendation continues to keep me on my side, even though I'm not putting it behind me, I'm putting my head on it. Go figure. All I can think of is a) having neck and spine aligned, or b) pillow doesn't get warm, is making me more comfortable? I dunno, I'm guessing. Even so, I'd really like get "back on my back" when I feel like it. I fall asleep faster, and I think it's just my natural sleeping position. Last night I slept the entire night on my side, don't think I moved at all. I attribute this to a not-so-good sleep on Friday night, and I was busy outdoors for most of the day, and it was pretty darn hot here in the Dallas area. I was READY to sleep last night.

The SH charts aren't from the the high AHI night for the week, it's from the worst night of sleep. Was having trouble staying asleep at start of night, then was dreaming and couldn't get back to sleep. Ended up taking a break, and fell asleep on my back when I returned to bed.

I haven't reached that low pressure value that *might* prevent events, so I'm planning to baby-step the min pressure up to 9.8 or 10 . Had no signs of aerophagia at all this week, so max pressure to 18. Sound reasonable?

[Pugsy]

Had no signs of aerophagia at all this week, so max pressure to 18. Sound reasonable?

Ah heck, at this point I would set it to 20 and forget it.

[djams]

Had no signs of aerophagia at all this week, so max pressure to 18. Sound reasonable?

Ah heck, at this point I would set it to 20 and forget it.

I know this would be best, my short run at 20 showed that I need it. Maybe my one night bout of aerophagia was a fluke. I'll give it a go again. Thanks Pugsy!

[djams]

More pillow talk. Last night I decided (for reasons that are unclear to me) that I'd switch back to my old soft pillow. Well, I lasted about 10 minutes. I just couldn't believe how uncomfortable the position got! Pretty astounding, I've only been using the buckwheat pillow for a week.

Then, driving to work today, I needed to turn my head to verify my blind spot. "Wow, that was easy". I couldn't miss the fact that I was able to turn my head without the normal amount of effort. Usually, seems like I get resistance right around 75 degrees rotation and have to work to get the rest of the way. Still have the crackling/grinding feeling, but rotational range seems improved. After one week.

I've concluded that there's really something to this "neck and spine aligned" thing. Buckwheat pillow is a keeper, and I'd recommend it.

I think plenty of people won't like it because it isn't cushy and soft like regular pillows, so probably not for everyone. But you won't know until you try.

[djams]

Another good week. Average AHI 1.14, Max 2.77, Min 0.15

You can see I didn't take the repeated advice to set the max to 20 and forget it. I decided I'd rather not have another round of aerophagia. That was truly awful. I'm actually glad that I only moved up to 18, because 4 times during the week I woke up with the machine blowing at max pressure and just went back to sleep. Up to now, I've always pulled the tube and let the machine to it's auto-off thing, then start over. Feel like this is a significant psychological hurdle crossed. Also a couple of nights with no bathroom run, which I've read could start happening.

Other positive developments; in the chart below, you can see my bathroom run at 12:30, then I've got leaking around 12:45. My wife woke me up - "Dave, you're whistling". So I asked her in the morning if she noticed if I was on my side. Nope, on my back. So, the remainder of the night (which was pretty good) was on my back. Hoping that this means palerider's advice to "up the min pressure to prevent events" is starting to work. I believe I can see numerous examples of this throughout the week.

What I'm interested in this week, is to "get learned on how to interpret my CA's. I had 10 in the chart below. Count through the week is: 0,0,4,0,0,10,6. There's a cluster of 6 at the beginning of the night. For the first 2, I don't see anything going on that would cause them, so do I assume this is SWJ? For the 2nd group of 4, there's FL prior, but not during the CA's. Don't know what to make of this. Please advise. None of this woke me up. Also, my impression is that these are nothing to be concerned about - is that correct?

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Zoomed

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[Pugsy]

Can you zoom in a little closer? I can't really tell at this level of zooming and it might not be so easy even with close up.
Might be one of those where we say maybe real...maybe SWJ.

Remember it's normal to have a few real centrals during the night anyway...like sleep onset centrals or a sleep stage transition centrals. It's possible you had a minor arousal or awakening so brief you don't remember it and then when you fall back to sleep it's possible to have a sleep onset central which is entirely normal.
Sometimes we can't always tell for sure by zooming in..and sometimes it's so evident a blind man could see it.

At any rate...even if every single one of your centrals was the real deal...you aren't having nearly enough of them to warrant concern.
For this few of events...personally I don't even bother zooming in. No matter what a small cluster might be unless I see a lot of those clusters in a night. Random...I don't even give a second glance...and besides not much I could do about them anyway.

[djams]

Thanks Pugsy. I'm switched into chore mode right now, I'll reply later with the closer zoom. I'm very interested in hearing what you've got to say.

Is anything necessary besides the flow rate chart?

[Pugsy]

No, don't need anything but the flow chart and you might need more than one image to get those events.

No guarantee that I can tell if you were asleep or not. It's not something I am very good at when the flow rate isn't clear cut different. Sometimes I just can't tell and I have to say "maybe".
Some of the others are more comfortable calling them than I am. It's really an educated guess sometimes.

[djams]

Here are charts zoomed on the cluster of 6 that start at 10:20.

In Flow rate-3, the first CA is the same one as the last CA on Flow-Rate-2

I'll be interested to hear your conclusion, even if it's maybe. I understand from reading other posts that this isn't cut and dried situation. I've got to say that with the exception of a small area on Flow Rate-2, none of this looks like my normal zoomed-in flow rate. So I'm not sure if I've captured enough here.

All comments welcome.

[Pugsy]

Zoomed in a little to close maybe...but they appear more real/asleep than SWJ to me.

This level of zooming in.

[djams]

Zoomed in a little to close maybe...but they appear more real/asleep than SWJ to me.

Was afraid of that (zoomed too close). And I have no reason to believe I was awake or half-awake at this time.

Thanks for the example. What I noticed immediately, is the scale: - +/-70 vs +/-180 auto-scaling on my screenshots. There was a 4 minute on your example, I managed to get right under 5, and I changed the Y axis scaling to +/-70 to be more in line with your example. Quite the trick, SH like to play "hide the popup" with me while trying to change this.

Here's one more try.

[Pugsy]

Much better. Thank you.
I think those 3 CAs are post arousal...not real in the sense that you just quit breathing in the middle of being asleep.
We don't always have any conscious memory of an arousal...we have to wake up long enough to form a memory of it to remember it.

See the bigger breaths starting around 22:30:15 and 22:30:30...That is not asleep breathing.
Look how it compares to the breathing right at the beginning of the snippet at 22:31:00 which I am fairly sure is asleep breathing. Now what caused the arousal...I can't see anything that might suggest something related to breathing itself being restricted unless it happened prior to 22:31:00. My best guess...arousal irregular breathing from 22:32:15 to the end of the snippet where right at the end of the flow rate at the breaths start to smooth out and the last 2...looks like going back to sleep. Arousal and you just paused your breathing a little (we do it all the time while awake and don't even notice it) and you got 3 CA flags. Hold your breath for 10 seconds...that's equivalent of a 10 second central/CA. Won't hurt you or cause you distress even if you do it 3 times in a row.
Now it is possible that those centrals are sleep onset centrals especially the last 2...like you were just starting to fall back asleep. It's normal to have a few sleep onset centrals and they aren't usually a cause for alarm unless we see truck loads of them or the keep bouncing you out of sleep and won't let you go on into sleep.

That's what I mean when I say the arousal caused the central because if we hadn't been woke up then we wouldn't be having any normal sleep onset centrals.

Below is a flow rate chart from a different machine and different software that let's you get a bigger overview of the asleep vs arousal flow rate pattern. Makes it a lot easier to see (the only thing I like about Respirionics and Encore is this graph).
This person doesn't have OSA..and in fact had a sleep study that gave him an AHI of 0.8.
Pretty much all the flagged events shown on the graphs...not real..sleep/wake/junk. He has crappy sleep but it is not from OSA. I did run this guys reports by a sleep tech just to make sure that what I thought I was seeing was correct. He agreed with me.

I know it looks like his AHI is high and his OSA isn't being well treated but he doesn't have OSA and it's pretty obvious when he was asleep and when the arousal breathing get so irregular and it's not from OSA.
This guy was hoping that using cpap would help with the arousals (which he did have a lot of spontaneous arousals during his sleep studies and only a handful that were breathing realated. It did help with the breathing related arousals but of course did nothing for the spontaneous arousals. CPAP couldn't fix his sleep problem because his sleep problem isn't related to restricted breathing. He just gets crappy sleep because of the spontaneous arousals and no one can figure out what is causing them.



and a section where some half way decent sleep was seen.

[Pugsy]

Now here's the deal with newbies and arousals...it's common because the brain just hasn't come to grips with this new alien being stuck on its human's face blowing air up the nose. So it will tend to want to wake its human to alert the human about this "thing" on its face. So it's common for newbies to see this post arousal stuff and the fix for it is time and experience so that the brain becomes one with its new best friend and quits poking you in the middle of the night to warn you about this "thing" on your face.

This is where the give it time thing comes in with this therapy when everything else looks decent...we have to give the brain time to be okay with the alien and quit poking you to warn you ""hey dude, there's an alien stuck on your nose" kind of thing.

For me...it took probably 4 to 6 months before I quit having arousals (that I remembered even) just from the my brain poking me. It was a very gradual reduction for me.
Now some people get lucky and the brain falls in love with the alien on its human's face right away and doesn't feel the need to alert the human by causing the arousal pokes.
Just like everything else that comes with this cpap therapy...comes with a big YMMV sticker.

I think you are doing very well and just need to give your brain time to fall in love with its new best friend.
You will have some off nights for sure...heck I still have them now and then after 9 years of this stuff.

[djams]

Everything, in both replies.

Wow. What a great response. I was wanting to learn what to look for, and I have been schooled. I was wondering about "bigger breaths starting around 22:30:15 and 22:30:30...", your explanation makes perfect sense. I see it, and I understand. And as I'm typing this post, it dawned on me that my wife watches the 10pm news until she's seen enough, and then comes to bed. This involves putting the dog in his crate at the end of the bed, and while she tries to be quiet, the latch makes noise and sometimes wakes me up. I'll bet that's exactly what happened here.

I've got a feeling you're correct in saying that especially the last two could be sleep onset centrals. I've caught myself in that situation, even prior to xPAP. I read until I'm ready to fall asleep. The first sign that I need to put the Kindle down is that it slips slightly in my hand and this wakes me up from very light sleep. And there were instances that this happened and I recall thinking to myself, "geez, take a breath". Maybe, maybe not, but it's great to know how you're evaluating this. Main thing I was after.

That Encore chart does indeed make the awake breathing much easier to spot, I see why you like it. I'm curious what the black dots on the pressure line mean.

Now here's the deal with newbies and arousals...it's common because the brain just hasn't come to grips with this new alien being stuck on its human's face blowing air up the nose. So it will tend to want to wake its human to alert the human about this "thing" on its face. So it's common for newbies to see this post arousal stuff and the fix for it is time and experience so that the brain becomes one with its new best friend and quits poking you in the middle of the night to warn you about this "thing" on your face.

This is where the give it time thing comes in with this therapy when everything else looks decent...we have to give the brain time to be okay with the alien and quit poking you to warn you ""hey dude, there's an alien stuck on your nose" kind of thing.

The brain needs to get on-board, 'cause this isn't going to change! (Mine's always been a slow learner). I'm already thinking about finding a backup machine, I never want to sleep without APAP again. It's a minor miracle for me so far. My machine was brand new, but it's still possible for the unthinkable to happen.

I think you are doing very well and just need to give your brain time to fall in love with its new best friend.

I feel like I'm doing well also, after all the wonderful advice and guidance from you and palerider. And I understand everything SO much better. Not a mystical black box anymore. I can't thank the two of you enough, I sincerely appreciate your help immensely!

And look what happened last night for the first time. Didn't think it possible for me. Had 5 RERA's, so it's just a no-hitter, not a perfect game.
Don't worry, I'm not reading too much into this. I know how and why I jump around. Just had to share.

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